Discordance between pain and radiographic severity in knee osteoarthritis: Findings from quantitative sensory testing of central sensitization

AbstractBackground and aimsSex differences in clinical pain severity and response to experimental pain are commonly reported, with women generally showing greater vulnerability. Affect, including state (a single rating) and stable (average daily ratings over two weeks) positive affect and negative affect has also been found to impact pain sensitivity and severity, and research suggests that affect may modulate pain differentially as a function of sex. The current study aimed to examine sex as a moderator of the relationships between affect and pain-related outcomes among participants with knee osteoarthritis (KOA).MethodsOne hundred and seventy-nine participants (59 men) with KOA completed electronic diaries assessing clinical pain, positive affect, and negative affect. A subset of participants (n = 120) underwent quantitative sensory testing, from which a single index of central sensitization to pain was derived. We used multiple regression models to test for the interactive effects of sex and affect (positive versus negative and stable versus state) on pain-related outcomes. We used mixed effects models to test for the moderating effects of sex on the relationships between state affect and pain over time.ResultsSex differences in affect and pain were identified, with men reporting significantly higher stable positive affect and lower central sensitization to pain indexed by quantitative sensory testing, as well as marginally lower KOA-specific clinical pain compared to women. Moreover, there was an interaction between stable positive affect and sex on KOA-specific clinical pain and average daily non-specific pain ratings. Post hoc analyses revealed that men showed trends towards an inverse relationship between stable positive affect and pain outcomes, while women showed no relationship between positive affect and pain. There was also a significant interaction between sex and stable negative affect and sex on KOA-specific pain such that men showed a significantly stronger positive relationship between stable negative affect and KOA-specific pain than women. Sex did not interact with state affect on pain outcomes.ConclusionsFindings suggest that men may be particularly sensitive to the effects of stable positive affect and negative affect on clinical pain. Future work with larger samples is needed in order to identify potential mechanisms driving the sex-specific effects of affect on pain.ImplicationsThe current study provides novel data that suggesting that the association of positive affect, negative affect, and pain are different in men versus women with KOA. Further understanding of the difference in affective expression between men and women may lead to the development of novel therapeutic interventions and help to identify additional modifiable factors in the prevention and management of pain.

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Expanded Distribution of Pain as a Sign of Central Sensitization in Individuals With Symptomatic Knee Osteoarthritis

Physical Therapy ◽

10.2522/ptj.20150492 ◽

2016 ◽

Vol 96 (8) ◽

pp. 1196-1207 ◽

Cited By ~ 45

Author(s):

Enrique Lluch Girbés ◽

Lirios Dueñas ◽

Marco Barbero ◽

Deborah Falla ◽

Isabel A.C. Baert ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Central Sensitization ◽

Quantitative Sensory Testing ◽

Clinical Symptoms ◽

Sensory Testing ◽

Knee Oa ◽

Pressure Pain Thresholds ◽

Symptomatic Knee Osteoarthritis ◽

Pain Frequency ◽

Pain Drawings

AbstractBackgroundExpanded distribution of pain is considered a sign of central sensitization (CS). The relationship between recording of symptoms and CS in people with knee osteoarthritis (OA) has been poorly investigated.ObjectiveThe aim of this study was to examine whether the area of pain assessed using pain drawings relates to CS and clinical symptoms in people with knee OA.DesignThis was a cross-sectional study.MethodsFifty-three people with knee OA scheduled to undergo primary total knee arthroplasty were studied. All participants completed pain drawings using a novel digital device, completed self-administration questionnaires, and were assessed by quantitative sensory testing. Pain frequency maps were generated separately for women and men. Spearman correlation coefficients were computed to reveal possible correlations between the area of pain and quantitative sensory testing and clinical symptoms.ResultsPain frequency maps revealed enlarged areas of pain, especially in women. Enlarged areas of pain were associated with higher knee pain severity (rs=.325, P<.05) and stiffness (rs=.341, P<.05), lower pressure pain thresholds at the knee (rs=−.306, P<.05) and epicondyle (rs=−.308, P<.05), and higher scores with the Central Sensitization Inventory (rs=.456, P<.01). No significant associations were observed between the area of pain and the remaining clinical symptoms and measures of CS.LimitationsFirm conclusions about the predictive role of pain drawings cannot be drawn. Further evaluation of the reliability and validity of pain area extracted from pain drawings in people with knee OA is needed.ConclusionExpanded distribution of pain was correlated with some measures of CS in individuals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is needed.

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Central Sensıtızatıon ın Axıal Spondyloarthrıtıs: An Exploratıve Study wıth Quantıtatıve Sensory Testıng and Clınıcal Scales

Modern Rheumatology ◽

10.1093/mr/roab110 ◽

2021 ◽

Author(s):

Feyza Nur Yücel ◽

Mehmet Tuncay Duruöz

Keyword(s):

Central Sensitization ◽

Quantitative Sensory Testing ◽

Axial Spondyloarthritis ◽

Pressure Pain Threshold ◽

Female Gender ◽

Pain Modulation ◽

Sensory Testing ◽

Clinical Scales ◽

Significant Difference ◽

And Control

ABSTRACT Objective To evaluate the central sensitization (CS) and the related parameters in patients with axial spondyloarthritis (axSpA). Methods Quantitative sensory testing (QST) which consists of pressure pain threshold (PPT), temporal summation (TS), and conditioned pain modulation (CPM) were applied to the participants. Disease activity, functional status, sleep quality, pain, depression, and fatigue were assessed. Patients were divided as the ones with and without CS according to the central sensitization inventory (CSI) and the results were compared. Results One hundred patients and fifty controls were recruited. Sixty axSpA patients had CS. When QST results were compared between the patient and control groups, all PPT scores were found lower (p<0.05) in patients. Regarding the comparison of the patients with and without CS, sacroiliac, and trapezius PPT scores were found lower in the patients with CS (p<0.05). On the other hand, there was no significant difference in the mean TS scores (p>0.05) between patients and controls, and in patients with and without CS. All investigated comorbidities were found to be significantly more frequent (p<0.001) in the patients with CS. In regression analysis female gender, morning stiffness duration, CPM, depression, and fatigue were detected as related parameters with CSI scores. Conclusion CS and related comorbidities were found to be increased in axSpA patients. This increase should be taken into consideration in the management of these patients.

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Test–retest reliability of Quantitative Sensory Testing in knee osteoarthritis and healthy participants

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2011.02.009 ◽

2011 ◽

Vol 19 (6) ◽

pp. 655-658 ◽

Cited By ~ 79

Author(s):

V. Wylde ◽

S. Palmer ◽

I.D. Learmonth ◽

P. Dieppe

Keyword(s):

Knee Osteoarthritis ◽

Quantitative Sensory Testing ◽

Sensory Testing ◽

Retest Reliability ◽

Test Retest Reliability ◽

Healthy Participants

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Convergent Validity of the Central Sensitization Inventory in Chronic Whiplash-Associated Disorders; Associations with Quantitative Sensory Testing, Pain Intensity, Fatigue, and Psychosocial Factors

Pain Medicine ◽

10.1093/pm/pnaa276 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3401-3412

Author(s):

Erwin Hendriks ◽

Lennard Voogt ◽

Dorine Lenoir ◽

Iris Coppieters ◽

Kelly Ickmans

Keyword(s):

Psychosocial Factors ◽

Central Sensitization ◽

Convergent Validity ◽

Quantitative Sensory Testing ◽

Temporal Summation ◽

Sensory Testing ◽

Pressure Pain Thresholds ◽

Central Sensitization Inventory ◽

Whiplash Associated Disorders ◽

Chronic Whiplash

Abstract Objective Central sensitization is present in different pain conditions, including chronic whiplash-associated disorders. In the absence of a gold standard method of assessment to determine the presence of central sensitization, quantitative sensory testing is currently understood as an optimal proxy. Laboratory sensory testing is, however, not feasible in clinical practice, and the Central Sensitization Inventory was developed as an alternative. The aim of the current study was to evaluate the convergent validity of the Central Sensitization Inventory in chronic whiplash-associated patients by determining the association between the Central Sensitization Inventory and quantitative sensory testing, pain intensity, fatigue, and psychosocial factors. Methods A total of 125 chronic whiplash-associated patients completed multiple questionnaires and were subjected to pressure pain thresholds and temporal summation. Results . The Central Sensitization Inventory showed a strong association with constructs of general psychopathology, anxiety, distress, depression, and somatization in chronic whiplash-associated disorders. Moderate correlations were found with fatigue and intrusive and avoidant phenomena after a variety of traumatic events. No significant association was found between the Central Sensitization Inventory and pressure pain thresholds and temporal summation, nor between the Central Sensitization Inventory and other pain measurements. Conclusions Overall, we found that the Central Sensitization Inventory is better in identifying the psychosocial factors related to central sensitization in chronic whiplash-associated disorders than the central nervous system adaptations. Thus, the convergent validity of the Central Sensitization Inventory appears to be only partially present in chronic whiplash-associated disorders.

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